Disclaimer: This information is not medical advice and should not be treated as such. This post is for general educational purposes only and you should consult with a licensed healthcare provider for specific guidance.
I get asked quite often “I have this ache or pain, what do I do?” While specific aches and pains need a bit more assessment*, there are general strategies that you can implement today for musculoskeletal pain. We are focusing on strategies that are efficient in terms of time and money, as well as, have minimal side effects.
1. Improve sleep hygiene.
Sleep not only influences our body’s ability to recover after injury, but also influences our perception of pain. Studies demonstrate a connection between poor sleep and perception of pain [1, 2]. Furthermore, sleep disturbances are considered a risk factor for developing chronic pain . Here are a few simple tips from the Centers for Disease Control and Prevention (CDC), that require minimal initial investment (<$10):
-Have a consistent bedtime and wake up time
-Keep your bedroom dark, quiet, relaxing and at a cool, comfortable temperature
-Avoid caffeine, alcohol, large meals or lots of fluid intake before bed
-Don’t use electronic devices in the bedroom-it should be for sleep and sex only
If you still have sleep difficulties even with implementing these steps, consult a licensed practitioner who can help further with issues such as sleep apnea.
2. Exercise daily, especially aerobic exercise
Research shows that aerobic exercise performed at least 75% of VO2 Max  or roughly at an intensity where you can talk, but not sing, decreases sensitivity to pain. Aerobic exercise has been recommended as part of a treatment approach for chronic pain . This can take a variety of forms such as walking, swimming, biking, rowing, dancing, and more.
3. Manage stress levels
Stress and our emotional state influences our perception and response to pain. Research shows that cognitive stressors can significantly impact our perception of physical pain . Beyond that, stress has real physiological effects (such as elevating cortisol levels and increasing inflammatory markers) that directly affect whatever tissue may be irritated . Ideally, we want to remove chronic stressors, however this is often not possible. Fortunately, there are tools that you can use today, recommended by the American Psychological Association (APA), that can help mitigate the effects of chronic stress:
-Eat a well-balanced diet
-Perform muscle relaxation exercises-Perform mindfulness based meditation
-Get regular physical activity
-Spend time in nature
-Take time for pleasurable leisure activities
If you chronically struggle to manage stress, even with interventions like the ones described above, consult a licensed practitioner for further guidance.
4. Try thermal modalities like ice packs, heating pads/hot packs/hot baths
For acute injuries, I recommend the updated guidelines of “PEACE & LOVE” (the updated version of “RICE”) and consulting a licensed medical provider. However, after the acute injury phase, the response to hot or cold varies by individual. Some people swear by ice packs. Others love hot Epsom salt baths. Overall, I feel comfortable recommending trying hot or cold since they typically have no side effects and are highly accessible.
5. See a qualified physical therapist or other musculoskeletal provider
If the first four steps don’t work, I’d recommend a formal consult with a clinician (like myself or others)* who is familiar with the biopsychosocial model and promotes a proactive, independent approach to rehab.
What is the biopsychosocial model? This is an emerging model that views pain as a multifactorial experience. Many factors such as your stress levels, sleep quality, emotional state, and what is happening at a tissue level play a role in your experience of pain and your response to it. The experience of pain can occur with or without actual tissue damage. In contrast, older models of rehab viewed pain through a purely “biomechanical” lens, meaning that pain only occurs because a tissue is damaged e.g. your back pain hurts only because you didn’t “lift with your legs”. A good clinician can help you determine what factors to focus on and how, in order to maximize your recovery.
So there we have it, some general strategies for managing musculoskeletal pain. In another post we’ll cover exercise modification in the presence of pain!
*I recommend a formal consult because:
- Without more information (i.e. pain/injury history, beliefs about pain, lifestyle factors, medical history, etc.), a clinician cannot accurately determine what factor relate to someone’s pain. I cannot responsibly recommend specific solutions without further assessment.
- Interventions for pain and returning to activity tend to work best with coaching and feedback, rather than a one off answer. For example, if someone has knee pain during a squat, we might try different ranges of motion to find a squat that doesn’t exacerbate symptoms. Then we might examine their symptoms after 24 hours and over weeks of training and adjust accordingly. There is simply too much feedback to be encapsulated in a “just do this one thing” recommendation.
- Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: an update and a path forward. The journal of pain, 14(12), 1539–1552. https://doi.org/10.1016/j.jpain.2013.08.007
- Wei Y, Blanken TF, Van Someren EJW. Insomnia Really Hurts: Effect of a Bad Night’s Sleep on Pain Increases With Insomnia Severity. Frontiers in Psychiatry. 2018 ;9:377. DOI: 10.3389/fpsyt.2018.00377. PMID: 30210367; PMCID: PMC6121188.
- Generaal, E., Vogelzangs, N., Penninx, B. W., & Dekker, J. (2017). Insomnia, Sleep Duration, Depressive Symptoms, and the Onset of Chronic Multisite Musculoskeletal Pain. Sleep, 40(1), 10.1093/sleep/zsw030. https://doi.org/10.1093/sleep/zsw030
- Jones, M. D., Booth, J., Taylor, J. L., & Barry, B. K. (2014). Aerobic training increases pain tolerance in healthy individuals. Medicine and science in sports and exercise, 46(8), 1640–1647. https://doi.org/10.1249/MSS.0000000000000273
- García-Correa, H. R., Sánchez-Montoya, L. J., Daza-Arana, J. E., & Ordoñez-Mora, L. T. (2021). Aerobic Physical Exercise for Pain Intensity, Aerobic Capacity, and Quality of Life in Patients With Chronic Pain: A Systematic Review and Meta-Analysis. Journal of physical activity & health, 18(9), 1126–1142. https://doi.org/10.1123/jpah.2020-0806
- Marie Hoeger Bement, Andy Weyer, Manda Keller, April L. Harkins, Sandra K. Hunter, Anxiety and stress can predict pain perception following a cognitive stress, Physiology & Behavior, Volume 101, Issue 1, 2010, Pages 87-92, ISSN 0031-9384, https://doi.org/10.1016/j.physbeh.2010.04.021.
- Hannibal, K. E., & Bishop, M. D. (2014). Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Physical therapy, 94(12), 1816–1825. https://doi.org/10.2522/ptj.20130597